Standing Committee B

Mr. Win Griffiths in the Chair]

Health (Wales) Bill

Clause 4 - Health Professions Wales

Bill Wiggin: I beg to move amendment No. 12, in
clause 4, page 3, line 20, leave out subsection (3).

Win Griffiths: With this we may take amendment No. 16, in
clause 4, page 3, line 20, after 'functions', insert 'in relation to health care professions and health care support workers'.

Bill Wiggin: First, the Hansard for our previous afternoon sitting is not available. I asked for it yesterday, but it is not here. I see that you have taken care of it already, Mr. Griffiths.

Win Griffiths: I have already been informed that, in this modern day and age, the IT system is causing problems. It is hoped that the proceedings will be published on the internet on Saturday and that the hard copy will be available on Monday. Apologies, but it is beyond our control.

Bill Wiggin: Thank you, Mr. Griffiths.
 In August 1997, the Health Professions Wales was one of four UK health departments commissioned to review the statutory framework for the regulation of nursing, midwifery and health visiting. The report recommended a smaller and more efficient UK-wide body, the Nursing and Midwifery Council. That explains the roots of the Health Professions Wales. At the same time it was decided to replace the Council for Professions Supplementary to Medicine, established under the Professions Supplementary to Medicine Act 1960, with a more focused Health Professions Council. 
 The two orders establishing those bodies were approved by Parliament and made on 12 February 2002. The orders provided that the National Assembly for Wales may create or designate a body with which each council may enter into arrangements for ensuring that the councils' standards for education were being met. Since that date, a shadow HPW—technically within the Assembly, but in fact a continuation of the WNB—has been fulfilling the necessary functions. The shadow body has 23 employees and costs £1.5 million a year. Clause 6 will provide a proper statutory footing and a welcome degree of independence. 
 The new HPW has an ambitious agenda, extending some way beyond that of its predecessor. The National Assembly Minister confirmed that Wales was taking a lead in creating the HPW, but emphasised that it was early days yet and that she was in regular consultation with other Health Ministers in the UK. UK standards were indeed envisaged, which brings me back to the 
 fact that the original idea was to have a UK-wide body, in respect of exercising functions relating both to health care professions and to health care support workers. I hope that that explains why it is important to incorporate reference to both within the Bill. 
 Witnesses to the Select Committee raised the possibility of problems arising from the power of the Assembly to direct the HPW, cutting across the proper performance of its functions carried out on behalf of the NMC or the HPC. The Select Committee recommended that the National Assembly's power of direction to the HPW should expressly require prior consultation regarding functions carried out by the HPW on behalf of the HPC or NMC. 
 During my research, I have followed up quite a lot of the evidence given to the Select Committee. The Nursing and Midwifery Council welcomed the establishment of Health Professions Wales and noted that its functions related to health care professions and health care support workers. While the NMC does not anticipate that there will be occasions when a direction from the Assembly would run counter to the requirements of either the NMC or the Health Professions Council, it notes that the possibility exists. 
 Equally, it noted that the Bill will give the Assembly powers to abolish Health Professions Wales. Should that power be exercised, it will expect that any organisation that has entered into contractual relationships with the HPW would be given due notice so that appropriate and effective arrangements could be made. It is worth drawing the Committee's attention to the health care professionals within the remit of the HPW. They include arts therapists, clinical scientists, dieticians, health visitors, medical laboratory scientific officers, medical physicists, medical physics technicians, midwives, nurses, occupational therapists, orthoptists, paramedics, physiological measurement technicians, physiotherapists, podiatrists and chiropodists, prosthetists and orthotists, radiographers and speech and language therapists. I could perhaps do with a bit of speech and language therapy at this early hour. I put it down to the fact that I have not had my Weetabix yet. 
 Health Professions Wales also gave evidence to the Select Committee. It will liaise with Healthwork UK and other UK in order to maintain a UK-wide perspective in the development of a coherent approach to education and training within the health care sector work force in Wales. It will represent and work with employers and other relevant bodies in conjunction with Healthwork UK to support implementation of lifelong learning within the health care sector. That phrase ''within the health care sector'' recurs throughout the evidence. It will work with the midwives and the health service organisations in Wales and will advise on work-based learning and assessment of competence. It will also assist the clinical governance agenda to reduce poor performance in health service organisations across Wales. It is clear from the HPW's evidence to the Committee that it sees its mandate as being within, for and in relation to 
 health care professions and health care support workers. 
 Even Unison considers that the main advantage to such an organisation is that it consolidates the training and development of those staff groups into a single over-arching framework. It adds that it can be argued that it does not go quite far enough by not including doctors, consultants and other medical staff in such an organisation. Again, it is mainly a welcoming comment from Unison. 
 Interestingly, the Royal College of Nursing notes that it was unsure of the extent to which powers of direction granted to the Assembly were wholly appropriate. It felt that the Minister for Health and Social Services would, in effect, exercise those powers without the approval of the Health and Social Services Committee or the Assembly as a whole. It sought reassurance that the powers of direction outlined in clause 4(2)(c) and (4) were not intended to be used to undermine the necessary autonomy of the HPW. It felt that it was right that the Assembly as a body should be able to pass secondary legislation to set the parameters of the work of HCW, but added that ministerial intervention, through directions on what are essentially professional matters, will often not be desirable or appropriate. 
 The Government seem to have accepted the thrust of the Committee's concern that the ambit of the HPW should not be allowed to spread, but there is some doubt when reading subsections (2) and (3) as to whether functions to be conferred by Assembly orders are to be restricted to health care staff. For the avoidance of doubt, the amendment would be most helpful.

Don Touhig: I welcome you to the Chair, Mr. Griffiths, for what we hope will be our final sitting if we make good progress.
 Amendment No. 12 would remove subsection (3) and amendment No. 16 would insert a new set of words, making the Bill more narrow. I hope that I can convince the hon. Gentleman that the amendments are unnecessary and to reassure him in respect of the points that he made. 
 Modernisation and reform of the health service in Wales requires a flexible approach and the Assembly has to have the freedom to provide for changing standards in health care, training and development. The amendment would prevent that. Changes to the way in which individual professions work will give rise to new requirements for staff's continuing education and training. The amendment would prevent the Assembly from responding quickly and effectively to changing needs. 
 The Assembly intends to use the powers in subsection (3) to give the HPW responsibility for quality assurance in the continuing education and training of qualified nurses, midwives, health visitors, allied health professions and health care scientists in Wales. If the amendment is accepted, the Assembly would be unable, for example, to require the HPW to 
 accredit post-registration workplace and academic training, which would not benefit patients or the health service in Wales. The Assembly would not be able to ask the HPW to take important steps in developing a similar role in respect of health care support workers. 
 As to amendment No. 16, subsection (3) as drafted provides scope for the Assembly to confirm functions that it exercises on the HPW and the HPW can carry out those functions on behalf of the Assembly. The amendment would prevent the Assembly from conferring functions on the HPW other than those related solely and exclusively to health care profession and health care support workers.

Chris Grayling: Will the Minister clarify something? He said that the subsection referred solely to the transfer of functions carried out by the Assembly, but it does not actually say that. I hesitate to use a previous example, but if there were to be a much stronger nationalistic tone in the Assembly that said, ''We must have our own qualifications for Wales,'' is there anything in the clause to prevent the Assembly from saying to the HPW, ''We want you to develop entirely exclusive professional qualifications for Wales without reference to the rest of the United Kingdom''?

Don Touhig: I was just about to come to that point; I can allay the hon. Gentleman's worries. There is an important and subtle point of distinction that I want to get across in respect of the use of subsection (3): it will not permit the Assembly to confer a ragbag of unrelated functions on the HPW. Subsection (2) already provides that the HPW is to have functions in relation to health care professions and support workers, as conferred by clause 4, which includes those conferred under subsection (3). The point made by the hon. Member for Leominster (Mr. Wiggin) is covered in subsection (2).

Chris Grayling: I refer the Minister to subsection (7) which states:
''The Assembly may by order make provision about the constitution of HPW''.
 By definition, since the constitution would normally encompass the purposes of the organisation, in theory at least the clause would allow the Assembly completely to rewrite the purposes of the HPW.

Don Touhig: I aim to try to reassure the hon. Gentleman that it will not be possible to do that. I want to try to get across that although the Assembly may confer powers on the HPW that are not directly related to health care professions and health care support workers, because of the way that the clause is drafted, the HPW would be able to exercise those powers only in respect of health care professions and health care support workers, whatever the Assembly may do. That is the protection that I hope will persuade the hon. Gentleman that whatever a future Assembly might want to confer on the HPW, the functions that it can carry out relate only to health care professions and health care support workers. For that reason, the further limitation suggested by the amendment is unnecessary.
 The distinction is, as I have said, important, because subsection (3) relates to the Assembly's functions. The Assembly, like the Secretary of State for Health, has wide powers and duties relating, for instance, to the provision generally of a comprehensive health service. Those functions do not relate solely to health care professions and support workers, but their exercise may from time to time relate to, or affect, them. Subsection (3) is intended to allow the Assembly the flexibility to devolve such functions as it deems appropriate, to be exercised by the HPW in relation to health professions and support workers, as provided by subsection (2). 
 There is another, more practical, reason why the clause was drafted in that way. Some time ago, when the HPW's remit was being considered, a change management group was set up to consult and agree on the type of functions that the HPW should seek to serve. The group comprised many professional organisations and included doctors and dentists. Those professions did not wish to be included in the HPW, but they asked that provision be made for them to join at a later date if they perceived that that was to their advantage, or if their needs changed. There may be other professions that would benefit from being included in HPW's remit at some stage. 
 Constraining the Assembly's powers in the way set out in amendment No. 16 would limit the benefits that we could gain from the HPW and would fly in the face of the groups that have said that at some stage further down the line they may wish to consider coming within the orbit of the HPW. I have tried to assuage the proper and understandable fears raised by the hon. Member for Leominster and to show that the Bill contains proper protections.

Bill Wiggin: I am grateful to the Minister for making such a kind effort to persuade me that the provision is an excellent part of the Bill. Will he be so kind as to give examples of the powers that the Assembly is likely to give the HPW, and why does he consider that health care professions and health care support workers do not include doctors?

Don Touhig: I cannot be specific on the kind of powers that the Assembly might want to transfer to the HPW in future. I do not have a crystal ball. With the Bill, we are seeking to give flexibility for that position to be faced and met. On the hon. Gentleman's other point, we must remember that the change management group included doctors, dentists and other professionals, and they did not wish to be included in the HPW's remit at this time. As I have said, they asked that the Bill be so drafted that, should they consider some way down the line that they might want to come within the orbit of the HPW, that could happen. That is why we have drafted the Bill in this way. I hope that that persuades hon. Members that they need not pursue their amendments, and that they are satisfied with the provisions in the Bill.

Bill Wiggin: I am grateful to the Minister for trying, but I am not convinced, because I do not understand what the definition would have to be to allow doctors to join. The provision in the Bill does not fulfil the criteria and is far too general. If subsection (2) is the key part to restrict the Assembly to health and care
 support workers, that rather countermands the argument that the Minister has just advanced that doctors can be included. I hope that I am making myself clear, because a contradiction runs through his argument. Line 18 in page 3 suggests that doctors and other health professions are included, but line 20 suggests that they are not. I do not understand why it is possible to mention health care support workers at one stage, but not at the next. There is where the contradiction seems to bite hardest.

Don Touhig: I am sorry, but I must try to make this clear. I fully understand that this is a difficult and complex part of the Bill, but I am trying to explain that, as the Bill is drafted, other health professions will have the opportunity to come within the orbit of the HPW at some time in the future should they so wish. If we accepted amendment No. 16, that would be precluded, so I urge the hon. Gentleman to reconsider. At some stage, as developments take place, other professions might feel that they could benefit from being within the orbit of the HPW. However, the amendment would prevent that from happening.

Bill Wiggin: I hope that the Minister will take on board some of the points that I have made and consider being slightly more specific at a later date. At this stage, however, I am grateful to the Minister and for the indulgence of the Committee. I beg to ask leave to withdraw the amendment.
 Amendment, by leave, withdrawn.

Nigel Evans: I beg to move amendment No. 4, in
clause 4, page 3, line 29, at end insert—
'Provided that no arrangements entered into by HPW under this subsection shall lead to the creation of professional or training standards that differ in any respect from those established by the bodies with which HPW has entered into such arrangements.'
 I thought that it might be appropriate for the Committee to send its best wishes to Dr. Wen Guo Jiang and Dr. Tracey Martin of the University of Wales College of Medicine for their apparent breakthrough in breast cancer—a condition that kills 800 women in Wales every year. Every year, some 2,000 women are diagnosed with breast cancer, and the breakthrough is a remarkable achievement for two of our health professionals in Wales. I am sure that the Committee would want to congratulate them and wish them well for the future. 
 We can see from clause 4(4)(a), (b), (c) and (d) the wide relationship and powers that the Assembly will have over the HPW. It will be able to enter into arrangements with Health Professions Council, with the Nursing and Midwifery Council and with any other body for carrying out functions on behalf of those bodies in relation to Wales, and to carry out any such arrangements. 
 We want to ensure that there will be some coherence to the regulations and standards that are set, and that we are all saying the same thing. In many ways, the amendment is an extension of the amendments relating to the community health councils, which my hon. Friend the Member for 
 Epsom and Ewell (Chris Grayling) moved, with regard to such things as promotional campaigns and forming some sort of relationship with other, similar bodies in England and the rest of the United Kingdom. 
 We want our health professions, and health profession training, to be of the highest standard. Sadly, we know that mistakes are made in the medical profession, and that sometimes, although rarely, thank goodness, the highest standards are not met. We also want that high standard to match the standards that are required in the rest of the United Kingdom. We now have 1,000 nursing vacancies in Wales. We already know that up to 1,000 vacancies have been filled by nurses from the Philippines, and we are grateful to them for the work that they do in the national health service in Wales. At the same time, however, if we are going to seek out nurses in the rest of England, or if we want to ensure that there is flexibility of crossover between England and Wales, I hope that the standards that are attained in Wales will be similar to those attained in England, and vice versa. I cannot even envisage why we would want to impose certain restrictions on nurses in Wales or require them to have extra qualifications that would not already be required in England or the rest of the United Kingdom. 
 We are seeking to tease out why the Minister regards the amendment as unnecessary. Without it, how does he envisage the health professions in Wales entering dialogue with similar bodies in England to ensure equality of qualifications and training between Wales and England? Nurses in Wales may have to take on additional responsibilities—for example, giving injections to patients, something that in England, only doctors do so. Some nurses living in Bristol may work in English hospitals on some days of the week, and move into Wales on others. If different regulations applied in Wales, I fear that it would lead to confusion, irrespective of whether extra training were required.

Roger Williams: The hon. Gentleman will be aware of the debate about how community hospitals in rural Wales can continue to deliver maternity services, minor surgical operations and cardiac care. Although these hospitals can generally deliver a good standard of care, it is impossible to meet the gold standard expected in district general hospitals. Sometimes nurses will need to take on additional responsibilities that they would not take on in other circumstances.

Nigel Evans: I fully accept the need for flexibility. For the delivery of health care, it is important to train people as first aiders, particularly in rural areas where such help might be given before an ambulance arrives. Nothing should be done to prevent that. Defibrilators are also available, particularly in rural areas, so that someone having a heart attack can be kept alive before the health professions arrive to deliver the proper care. The hon. Gentleman talks about the gold standard—exactly what we are talking about. We do not want a gold standard in one area and a bronze standard
 somewhere else, and we are trying to deal with that problem today.

Chris Grayling: Does my hon. Friend share my view that the issues highlighted by the hon. Member for Brecon and Radnorshire (Mr. Williams) are by no means exclusive to Wales? They apply equally to rural areas throughout the UK. The application of central standards to other areas has more to do with the relationships between the royal colleges than the relationship between England and Wales.

Nigel Evans: I accept all of that. We are examining standards without precluding flexibility. I do not want to handcuff anyone. I want people to be able to move freely within the health service throughout the UK. In the event of an outbreak in west Wales, it is important to be able to secure the help of nurses from England without any hindrance in respect of their failure to reach the different requisite qualifications specified by the Welsh Assembly or other bodies in Wales.
 The MMR jab is a good example. Nurses in Wales may be expected to give the injections as well as advice to parents about the jab. Uniformity of advice is obviously important. It was sad to read that up to quarter of children in parts of south Wales have had no injection whatever, fuelling fears of an outbreak of measles or some other disease. That would create a huge problem for the resources available in Wales as well as for the children and parents affected. 
 I hope that the Minister can reassure us that the amendment is not necessary and that the dialogue that is needed to ensure that the proper gold standard of qualifications between England will be the same and that nurses and other health professions will be able to move freely between the borders.

Hywel Williams: I find it rather odd that the hon. Member for Ribble Valley (Mr. Evans) talks about matching and flexibility. The amendment talks about
''professional or training standards that differ in any respect''—
 not in most respects, thus allowing a bit of flexibility if something is going on down in south-west Wales, but ''in any respect''. It would therefore prevent Health Professions Wales from developing professional or training standards that might be peculiar to Wales, and that would respond to the circumstances in Wales such as culture and language. 
 Health professionals, almost by definition, work with people in the round, people who have a culture and a language. It is reasonable that they should respond to those aspects. Their patients are not things, but people in all their variety. There is a steep gradient of cultural change and variety in Wales. That is one of the glories of our country. There is a difference between this community and that community up the road: a difference between Cardiff and Islwyn or Cardiff and Caernarfon. Health professionals should be trained in an awareness of that variety. There is a difference almost from north Cardiff to the docks. People should be trained to understand and respond appropriately to those cultural differences. If they are trained, it is reasonable that they should also be assessed. There is no point in training people unless we 
 assess them and ensure that the outcome is consistent with the investment that we have put in.

Nigel Evans: I am trying to understand fully what the hon. Gentleman is saying. Is this something to do with the Welsh language? Does he expect nurses and other health professionals to speak in Welsh if that is their patient's first language?

Hywel Williams: The hon. Gentleman anticipates some of my later arguments. Initially I just want to concentrate on the cultural issue. As I said, we have a variety of culture in Wales and as health professionals work with people it is reasonable that they should be made aware of that cultural variety in their training.
 There is, of course, a difference in language. The language issue has a direct influence on practice. I can say that from 10 years' experience as a social worker both in the south Wales valleys and north-west Wales. Training for Welsh speakers may be peculiar to Wales. The hon. Members for Epsom and Ewell and for Ribble Valley seemed to assume that there was no difference between working with people in Wales and working with people in England. There is a difference in working with people who have a mental disorder, for example. If I had a mental disorder and was being seen by a nurse or a psychologist, I would certainly want that person to work with me in Welsh, even though I can speak English.

Chris Grayling: The hon. Gentleman may not be aware that the new regulations being introduced in relation to the General Medical Council omit to make any provision for English language competence for anyone choosing to come and work in the United Kingdom from overseas. Is the hon. Gentleman suggesting that a doctor trained in the Indian subcontinent, for example, who comes to work in this country and chooses to help to make up a shortfall of staff in Wales should not be required to be competent in English but should be required to be competent in Welsh?

Hywel Williams: The hon. Gentleman is anticipating some of my later arguments. I am not going to argue that every doctor, nurse and psychologist who works in Wales should be able to speak Welsh with their patients, but that some should be trained and able to do so.

Julie Morgan: I support some of the hon. Gentleman's remarks about the importance of being able to speak in their first language to people who live in Wales. Some years ago I experienced a distressing situation involving an elderly relative of mine who was mentally disordered and whose first language was Welsh. It was some time before a Welsh-speaking nurse was available to calm down my relative.
 As the hon. Gentleman said, one cannot expect every nurse and doctor to be Welsh speaking and we must approach the issue in a balanced, sensible way. However, it is important to have some people who can speak Welsh so that those in the situation of my elderly relative can be calmed and helped to feel more comfortable because a Welsh speaker is present.

Hywel Williams: The hon. Lady makes an important point in respect of people in some communities in south-east Wales who speak neither Welsh nor English as their first language. In my constituency, a small number—perhaps less than 1 per cent. of the population—speak what I call ethnic languages. Those people are even more isolated in my constituency because they do not have community support or access to people who can support them when they are receiving health care.
 I do not argue that every worker in the health service in Wales should be able to speak Welsh or any of the other languages spoken in Wales but the amendment is in respect of any difference—

Chris Grayling: I fully accept the desirability of having Welsh-speaking medical professionals in the health service in Wales. Does the hon. Gentleman not accept that the amendment is about standards, which apply across the board to every person in a health profession? In trying to meet the work force shortfalls in Wales, we are trying to ensure that it is possible for someone in England to move to Wales and work in the health service without having to retrain, which they may have to do if the amendment is not accepted. Surely the hon. Gentleman would not want that to happen.

Hywel Williams: Is the hon. Gentleman saying that even if it is desirable for some people to be able to converse in Welsh to their patients he will not train people to do so, nor will he assess their ability? It has to be one or the other. Either it is a legitimate occupational qualification for some workers in certain circumstances to be able to speak Welsh and people should be assessed and trained to do so if necessary or it is not and we must just hope that by luck or by chance someone will be available to speak in Welsh, English, Somali and so on.

Chris Grayling: Does the hon. Gentleman not recognise that we are talking about training standards, and about strict criteria for training, not about competencies that might apply within the profession. For example, let us suppose that that strict criteria requires a Welsh health professional to spend three months in an orthopaedic ward, but that English professionals have to spend only two months in such a ward. It would therefore be conceivable that before health professionals from England working in Wales could start work they will have to spend an extra month in an orthopaedic ward. That is what the amendment drives towards, not the desirability of having some competencies to a greater or lesser degree within professions.

Hywel Williams: We return to the question of what is competency to work in Wales. If we are talking about the standard, it is the ability to work properly and professionally with patients. If it is not a standard to be able to converse properly with people with organic brain illnesses, with young children who cannot speak English, with people who have had strokes, and with elderly people who are, essentially, monoglots, are we setting standards properly for those health professionals?

Nigel Evans: That is a red herring and it has nothing to do with the amendment. Of course we would want any health professionals to be able to communicate with the patients they are treating; that is by the by. As my hon. Friend the Member for Epsom and Ewell said, we are talking about standards. If a nurse in England can treat certain patients because of the qualifications she attained in England, she should also be able to treat the same patients in Wales, rather than being prevented from doing so because, for example, she has not done an extra month training in that particular speciality. The Welsh language has nothing whatever to do with it.

Win Griffiths: Order. For the sake of technical clarity, I remind hon. Members that if they do not talk at least vaguely in line with the microphone it is very difficult for Hansard to pick up what they say.

Hywel Williams: The hon. Gentleman and I are unlikely to agree on the matter; we are setting up a body for Wales. The frame of reference for me is Wales itself, not Wales as a subsidiary part of England. We should respond to health needs in Wales and if we are going to set the gold standard to which the hon. Member for Epsom and Ewell referred earlier, it should be a Welsh gold standard. I hope that the Committee will resist the amendment.

Don Touhig: We have had an unexpectedly wide-ranging debate. I associate the Government with a remark made by the hon. Member for Ribble Valley in respect of the Western Mail story. There can be no one in this Room whose life, or that of their friends or relatives, has not been touched by cancer and any breakthrough is most welcome. I am president of the Cancer Care charity in my constituency, which does wonderful work counselling people who have cancer. Any development that will help people to overcome that awful disease is to be welcomed. I endorse what the hon. Gentleman said in that respect.

Julie Morgan: I am sure that my hon. Friend is aware that the discovery was made by staff in the university of Wales medical college in Heath Park in my constituency. Does my hon. Friend agree that following the decision of the National Institute for Clinical Excellence to place its collaborative cancer work in Velindre hospital, and the £3.5 million given by the Assembly for radiotherapy treatment in Velindre, Wales is forging ahead in the treatment of cancer and is leading the way in the UK?

Don Touhig: I welcome that, and endorse what my hon. Friend said. Cancer is an awful disease that knows no boundaries and we welcome whatever can be done to advance its treatment and to find a cure.
 The amendment seeks to ensure that training standards for health care professionals are uniform throughout the United Kingdom, a matter that was mentioned in the previous sitting on Tuesday, but it misunderstands the nature of the arrangements that the HPW may enter into. Such arrangements will be entered into by agreement with the standard-setting bodies, so the HPW will not be empowered under such arrangements to act in a way that is not acceptable to 
 the standard-setting bodies. The HPW may undertake functions on behalf of the standard-setting bodies and in doing so it will apply their standards. The will not be involved directly in setting those standards; its role will be to ensure that UK-wide standards are applied within Wales. 
 The regulatory bodies are responsible for monitoring educational standards in the UK; the Nursing and Midwifery Council has a service level agreement with the HPW to carry out quality assurance activities in Wales on their behalf. There is a similar provision in the Health Professions Council order if they should wish to use the HPW to act on their behalf. The HPW should be able to assess the need for post-registration education and training of professionals according to the work force planning initiatives and the health policy developments in Wales and to support its development. Effective communication channels between the HPW, the NMC and the HPC will be important to ensure that the rules and processes required by the regulatory bodies are understood and implemented in Wales, and that the regulatory bodies know the policies and priorities in provisions for Wales. 
 I accept the point made by the hon. Member for Caernarfon (Hywel Williams) that we are talking about the training standards that need to be applied throughout the United Kingdom. I do not dismiss his arguments, but he is talking about a bolt-on provision that we would have to examine in Wales. I also take the point that there are people in Wales whose first language is neither Welsh nor English, and they also have to be cared for. Obviously, that would be part of any ongoing or additional training. As I said, we are talking about standards that will apply throughout the UK. The HPW will work completely within those arrangements and agreements, so the amendment is unnecessary.

Nigel Evans: I am grateful for the Minister's comments and I am reassured. He will understand why we tabled the amendments. We did not want to prevent any health professionals in England from being able to cross over easily if they worked for a time in the health service in Wales, or if they lived on the border but worked in hospitals in Chester or Bristol and in Newport, Cardiff or elsewhere in Wales.
 I accept the Minister's response to the amendment relating to the Welsh language and culture. We must recognise that, in parts of Wales, there are people who cannot speak English or Welsh and whose culture is completely different. We wish to be able to treat them for whatever ailments they have in the best possible way. That is a bolt-on provision, but an important one that needs to be considered. 
 I accept that, in various parts of Wales, there are still monoglot Welsh people. Welsh is their first language and they do not communicate in their daily lives in anything other than Welsh. In certain cases, if we gave them the gold standard of service described by the hon. Member for Caernarfon, it would be important that that could be done in Welsh, particularly if treating the patient's ailment specifically involved regular communication. If an injection were given, it would be important that 
 someone was available to communicate to the person what was happening. In that instance, it might not have to be the health professional who spoke Welsh, particularly if there was a shortage of those health professionals in that part of the country. I hope that the hon. Gentleman is reassured by my comments. 
 Given the Minister's comments, I beg to ask leave to withdraw the amendment. 
 Amendment, by leave, withdrawn. 
 Clause 4 ordered to stand part of the Bill.

Clause 5 - Further provision about HPW

Chris Grayling: I beg to move amendment No. 5, in
clause 5, page 4, line 24, leave out subsection (8).

Win Griffiths: With this we may discuss the following amendments: No. 13, in
clause 5, page 4, line 25, leave out subsection (9).
 No. 14, in 
clause 5, page 4, line 27, leave out 'or (9)'.

Chris Grayling: These amendments address another clause that appears to be rather generous in the powers that it hands to the politicians in the Assembly. That rather goes against some of the principles espoused yesterday by the Secretary of State for Health in his plans to devolve power into the hands of health professionals in communities in relation to a number of areas of our national health service.
 Conservative Members see the establishment of Health Professions Wales as potentially creative. It will be a significant body that can enable and develop the professions in different aspects of health care in Wales. Like other bodies of its kind, it should be strong, independent and health and medicine-oriented. It is the sort of organisation that must be run by people with the professional skills, knowledge and understanding to do the work that the Government have rightly identified as necessary for Wales. 
 This is primary legislation for health care in England and Wales, set out by the House in its role as deliver of such legislation. Why, then, does the Assembly need the power to abolish the body established by the Bill? There is no obvious or rational reason why the Assembly should want to abolish the HPW. The Government are taking a coherent step in creating a body that should have a long-lasting and central role in the development of health care professionals in Wales, so why the need for powers to abolish it? Once again it highlights the Bill's central flaw. 
 Broadly speaking, the Committee is agreed that the Bill is a decent set of steps, sensible, based on consultation and welcomed by health care professionals in Wales. That is why the Bill is not controversial and why we are spending relatively little time in Committee. Its main weakness is that in several different ways it hands excessive power to the politicians of the Assembly at the expense of the medical and health care professionals in Wales. I have cited the powers to abolish the HPW as one example. 
 The Assembly should not be given the right to abolish the HPW on a whim. I broadly accept the Minister's assurance that the Assembly has no intention to do so, but, with respect, the Minister has no crystal ball and cannot predict all circumstances—whether financial pressures or political ideology—in the short, medium or long-term future. Why confer on the Assembly the power to walk into the HPW and sequester assets, people and aspects of its operation? An ambitious Welsh Health Minister, seeking to strengthen his or her Department by gaining greater control over training in Wales, might remove that specialist department from the HPW and bring it into his own Department. The effect would be to destabilise the organisation by ripping out professional skills and economic assets, thereby undermining its financial structure. There is no need to do so, which is why we tabled the amendments to remove these provisions from the Bill. 
 The Government should have trust in what they are creating. They should not leave it to the vagaries of the Assembly's political will. The HPW should be a strong, independent, professional medical and health care body. Proposals to abolish it only weaken its strength and independence. We hope that the Minister will accept our amendments and remove these provisions.

Don Touhig: Rarely have we heard so many reservations expressed about politicians by politicians. It is quite extraordinary. We have already responded to concerns about the Assembly's powers. During pre-legislative scrutiny, the Royal College of Nursing asked for the removal of powers of direction under clause 4(2) and (4) and we responded positively to the request.
 The amendments would remove the reserve power of the Assembly to abolish Health Profession Wales and to make consequential provision for the transfer of its assets. The power is necessary for prudent management and I urge the Committee to retain it. Changes within the health service and the ways in which the professions work may give rise to new requirements for their continuing education and training. The support systems, including the HPW, may have to alter as a consequence. 
 I assure the Committee that the Assembly has no intention of using the power to bludgeon, threaten, or force the HPW to toe any line. The hon. Member for Epsom and Ewell referred to the possibility of an ambitious Health Minister in the future. It is a peculiarity of Wales that we do not look too well on ambitions. 
 I am reminded of a youngster who was walking on the quayside at Aberaeron and noticed some crabs crawling out of a bucket that had just been landed. He told the fisherman, who said, ''Don't worry, they won't get out; they're Welsh crabs, they'll all pull back.''

Chris Grayling: It is our sincere hope that this lack of ambition for the sons and daughters of Wales does not affect the Minister's own political career.

Don Touhig: That rests with people outside this Room, but mainly with the electorate.
 As I said, I assure the Committee that the Assembly has no intention of using the powers in any way to threaten or force the HPW to toe any line. It is not envisaged that the reserve power will be used, but it is a prudent power to have. The Assembly must be allowed to react quickly, if necessary, to developments in policy on the education and training of health-care professionals. 
 It may be useful to give one or two examples. The regulatory bodies, the Health Professions Council, or the Nursing and Midwifery Council may want to resume greater control of continuing education for the professions covered by the HPW. They may therefore want to consider withdrawing the agreement under which it is envisaged that the HPW would discharge those functions on their behalf, thus reducing or negating the role of the HPW altogether. If that meant that the HPW would no longer be viable, the Assembly would want the option of closing it down and reabsorbing any minor residual functions within the Assembly. If the HPW's role and function changes, it will be important to ensure that resources are used appropriately in delivering and supporting new ways of working. 
 The transfer of property and, more importantly, of staff, is always difficult and sometimes distressing. The provision allows the Assembly to make the necessary arrangements to ensure a smooth transfer that causes the least possible upset to the bodies concerned. I reassure hon. Members that no change would be made to the status of health profession roles without first conducting a full review of their functions and consulting key stakeholders throughout Wales. The aim of this and other provisions is to give the Assembly the powers and the flexibility that it needs to make policy as the situation in Wales requires. The amendment would defeat that purpose, and would mean that the Assembly would be forced to return to Westminster to seek further primary legislation to achieve its aims. I hope that the hon. Gentleman is reassured that there will be no great rush to damage or remove the HPW, but there must be a provision to take account of any changes in circumstances at some time in the future that might change the role of the HPW. We must be able to deal with such developments without coming back for more primary legislation.

Chris Grayling: The Minister still appears to be focused on the Assembly's current rather than future intentions. I would be more convinced by his arguments if he were arguing in favour of retaining subsection (9) to allow the flexibility to accommodate future developments and changes in the organisation.
 Subsection (8) seems to give draconian powers to the Assembly, but it is not worth taking up the Committee's time by forcing the matter to a vote. I beg to ask leave to withdraw the amendment. 
 Amendment, by leave, withdrawn. 
 Clause 5 ordered to stand part of the Bill.

Clause 6 - Powers of National Assembly for Wales

Question proposed, That the clause stand part of the Bill.

Chris Grayling: Subsection (2) refers to
''the power to make further Orders varying or omitting any such reference in that Schedule.''
 Will the Minister clarify whether that refers to orders made by the Welsh Assembly or to further orders to be made in this place?

Don Touhig: The National Assembly (Transfer of Functions) Order 1999 transferred to the National Assembly various functions approved by the Secretary of State for Wales. As such, it set out the position at a particular time. Since 1999, the position has changed, and many of the Acts under which these functions were conferred have been amended. Indeed, the Bill amends the provisions of the National Health Service Act 1977.
 That technical provision ensures that all amendments to the Bill will be carried through to the Transfer of Functions Order, thereby ensuring that the Assembly can undertake its functions in accordance with current legislation. Similar provisions affecting major amendments have appeared in other legislation—the National Health Service Reform and Health Care Professions Bill 2001, for example. It is important and necessary to provide for the transfer of functions. I hope that that deals with the hon. Gentleman's point.

Chris Grayling: With respect, the Minister has not answered my question. Could further orders be dealt with as part of the Assembly's operations or would they still need to be framed by this House?

Don Touhig: Further changes would require an Order in Council; the Assembly could not deal with it
 Question put and agreed to. 
 Clause 6 ordered to stand part of the Bill. 
 Clause 7 ordered to stand part of the Bill.

Schedule 3 - Minor and Consequential Amendments

Question proposed, That this schedule be the Third schedule to the Bill.

Chris Grayling: On a further point of clarification, the schedule refers to section 20A of the Community Health Councils (Access to Information) Act 1988 and to the Freedom of Information Act 2000. Those provisions are not referred to elsewhere in the Bill's documentation. May I clarify that section 20A refers to the amended title for schedule 1 rather than any other legislative reference?

Don Touhig: The amendments would ensure that the WCH is subject to all the normal rules that apply to public bodies, such as public admission to meetings, disqualification of members serving as MPs, freedom of information and so forth. Following amendments to the 1977 Act, CHCs will be subject to existing rules on access to and freedom of information. That is the
 whole purpose of the schedule and I hope that that deals with the hon. Gentleman's point.

Chris Grayling: May I check that the reference to section 20A relates to the National Health Service Act 1977 and that the section affects changes made to schedule 1?

Don Touhig: Section 20A is the new section inserted into the 1977 Act.
 Question put and agreed to. 
 Schedule 3 agreed to.

Schedule 4 - Repeals

Question proposed, That this schedule be the Fourth schedule to the Bill.

Bill Wiggin: I hope that the Minister has a copy of the National Health Service Act 1977 to hand: if not, it retails at £13. With my anorak firmly on, I apologise to the Committee, but admit that I checked the provisions last night. In chapter 49 of the 1977 Act I found the reference to
''section 18(1A), the ''or'' at the end of paragraph (a) and paragraph (c)''.
 Off I galloped, but found no section 18(1A)(c). It is not there, which, as I am sure you can imagine, Mr. Griffiths, created a crisis for me. There I was checking the wording: I found section 18(1A)(a) and (b), but found no more. Can the Minister explain what has happened to the missing bit? [Interruption.] I have some more, so perhaps I should carry on. I galloped on to section 98(2A) and found that that was not there either. It is either my fault for looking it up wrongly, or copious notes are winging their way to the Minister. One can only hope. If I cannot find the specified provisions in the 1977Act, it is difficult to approve the schedule.

Don Touhig: Section 10(1A) was added by the 2001 Act. The hon. Gentleman might have an old copy.

Bill Wiggin: It is section 18, not section 10. I may well have an old copy, but it was given to me by the Vote Office yesterday. Will the Minister look up section 98(2A)? Perhaps that is also missing for the same reasons. If this is an out-of-date copy, perhaps he could write to me about this. Could he also look at the National Health Service Reform and Health Care Professions Act 2002? That is a bargain at £10.50. The schedule refers to section 3(5)(a) and (c), which I naturally rushed to. This time, to my delight, they did exist; but the phrase
''In section 18 (directions and regulations under preceding provisions), in subsection (1A)''
 refers to my old friend the National Health Services Act 1977. Once again there were bits missing. Subsection (c) refers to a bit of the 1977 Act that does not seem to appear. I suspect that either my copy is out of date, or it is just a minor glitch. I should be grateful if the Minister could write to me about that.

Win Griffiths: Order. It may be helpful if I point out that there has been subsequent legislation and amendments have been made. We need to get the totally up-to-date version, which is found in Halsbury.
 I am sure that the Minister will have something else to add.

Don Touhig: I thank the hon. Member for Leominster for his helpful interventions. I shall write to him and all members of the Committee answering his points. Schedule 4 contains the required consequential repeals and I hope that the Committee will therefore endorse it.
 Question put and agreed to. 
 Schedule 4 agreed to. 
 Clause 8 ordered to stand part of the Bill. 
 Clause 9 ordered to stand part of the Bill.

Clause 10 - Short title, commencement and extent

Question proposed, That the clause stand part of the Bill.

Nigel Evans: I suspect that this speech will not take long. The Committee will be relieved that we will not be returning this afternoon. Clause 10(2) reads:
''This Act (apart from this section, section 8 and section 9) comes into force on such day as the National Assembly for Wales may by order appoint.''
 I can understand why sections 8 and 9 are excluded, but I assume that ''this section'' means the whole of clause 10. Why is that excluded too?

Chris Grayling: I want to refer the Minister to subsection (3), which contains the immortal phrase
''Different days may be appointed for different purposes.''
 I am sure that there is some arcane legal explanation for this, but it raises the question: what are we going to do with a Thursday? Perhaps a Monday should be used for different purposes. Will Health Professions Wales have a particular role on a Tuesday that a community health council will not have on Wednesday? Could the Minister enlighten us?

Don Touhig: The skills of the parliamentary counsel are there before us. Clause 10 provides that the Assembly may commence provisions of the Act, except clauses 8 and 9 and 10, which come into force on Royal Assent, on such days and for such purposes as it may decide. That is fairly common practice. It happens with all Bills that we take through. Unless we specify a date, it is left to the Minister or, as in this case, the Assembly, to decide the dates and which parts of the Bill will be enacted.

Chris Grayling: May I take the Minister back to subsection (3)? I appreciate that he may be hoping that an explanation drops from the heavens, but I am sure that he shares my slight puzzlement about what on earth happens on a different day and why we need to make legal provision for that to happen. I should be grateful if he would give us some idea of what on earth that legislation is talking about. [Interruption.] Perhaps I should say a little about Saturday and Sunday while the Minister seeks explanations from elsewhere. It may be that community health councils perform different functions at weekends or that the HPW will be closed at the weekend. CHCs may operate on only two days a week. The Minister will need to enlighten the
 Committee shortly, and I hope that he will be able to do so.

Don Touhig: The procedure used is fairly normal in legislation of this sort. It is perfectly clear to me that different days may be appointed for different purposes for the enactment of parts of the Bill. That is perfectly simple and should be clear to everyone.

Nigel Evans: If that provision were not in the Bill, what impact would that have on the Bill?

Don Touhig: It would certainly have avoided this discussion. As I understand it, the process used was the normal drafting process that applies when legislation of this sort is being enacted, and different days may be appointed for different purposes, and different parts of the Bill enacted. That will be a matter for the Assembly when Royal Assent does not cover it. Perhaps the hon. Gentleman will be content with that.

Chris Grayling: I am grateful for the Minister's explanation and I commend his detailed knowledge and understanding of the small print of the Bill. I am happy not to press the matter.

Don Touhig: Further to what I said, if matters were not specified as they are, the whole Bill would come into force on one day. The method used gives the Assembly the flexibility to have different days for different parts of the Bill.
 Question put and agreed to. 
 Clause 10 ordered to stand part of the Bill.

Don Touhig: Were there no new clauses?

Win Griffiths: There are no new clauses now. When clause 1 was ordered to stand part of the Bill, new clause 1 became redundant. Unfortunately for the hon. Member for Brecon and Radnorshire, the other new clauses fall outside the scope of the Bill.
 Question proposed, That the Chairman do report the Bill to the House.

Don Touhig: I thank you for that, Mr. Griffiths, and for the way in which you have chaired the Committee. You have guided us well in our good and wide-ranging debates. The Bill has proved the value of pre-legislative scrutiny, and I hope that we will continue that with other Bills that are introduced. It is also important to understand that this House still has an opportunity to scrutinise and challenge legislation, even when a Bill has been scrutinised previously as well as this one. It makes an important contribution to our continuing reforms in the health service in Wales, and will be very good for the people of Wales.
 I thank you, Mr. Griffiths, your officials, the police and all others associated with the conduct of the Committee. I thank my officials and hon. Members on both sides of the Committee for the contributions that they have made. We have done a thoroughly good job in record time, but we have not failed to scrutinise the Bill properly. Although we were unable to accept 
 amendments from the Opposition, their amendments were perfectly proper. They allowed the Government to place on the record our intentions in respect of the Bill, and the Opposition to express any concerns or worries that they had. I believe that the measure will be very successful as a result.

Nigel Evans: On behalf of the official Opposition, I extend warm wishes to you, Mr. Griffiths, to all the Officers of the House and to other individuals whom the Minister mentioned, for assisting the scrutiny and the smooth passage of the Bill. I, too, believe that the draft legislation helped to ensure that the Bill was altered in a way that it made it more acceptable to the Committee. We pressed some amendments to the vote because we believed that they would improve the legislation, but did not press others to the vote because they were probing.
 Perhaps the Government will take on board the fact that we finished scrutinising the Bill so early, and should not be so paranoid about the timetabling of legislation. It is important that we are shown more latitude in how much scrutiny we give to legislation in Committee. The fact that we finished early does not mean that the Bill has not been properly scrutinised. It will doubtless receive further scrutiny when it goes to the other place. Some of the clauses and amendments that we have considered today may give rise to further discussion. As the hon. Member for Brecon and Radnorshire said at the start of the proceedings, perhaps the Government will take some of our suggestions on board and table their own amendments, which may further improve the Bill. 
 It is important to improve the national health service as much as we can. We know that there are deficiencies in certain key areas, and establishing bodies such as the HPW and the Wales Centre for Health will do much to improve the quality of service and the retention of CHCs in Wales, which we applaud. We are only sorry that they have been scrapped in England.

Hywel Williams: On behalf of my party, I join hon. Members in thanking you for your chairmanship of the Committee, Mr. Griffiths. May I also express the wish that the passing of the Bill will lead to substantial improvements in the health service in Wales—improvements that are sorely needed.

Roger Williams: I echo the comments made by the hon. Gentleman and other hon. Members. The improvement of the health service in Wales is an absolute priority for the people of Wales, which the Bill, step by step, will go some way to achieving. I accept your ruling on our amendments, Mr. Griffiths, but that does not lessen our determination to table them at another time.
 Question put and agreed to. 
 Bill to be reported, without amendment. 
 Committee rose at twelve minutes past Ten o'clock.